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ASSOCIATED LA.BO ATo e <br /> 806 North Batavia ii, Orange, CA 92868LA\ <br /> Chain of Custody Record Phone (714) 771-6900 • Fax (714) 538-1209 <br /> Company (/ <br /> r� f / 1 C <br /> Project Manager��r � �� �� �o ��"► �`�� � A L Jab No ( Y t t)� Page of <br /> � ft'1.20 S i'�l G4— '5 r_ Analysis Requested Test Instructions&Comments <br /> Project Name * PrOJO&# <br /> Site Name �] <br /> and J"ffC4`F7~C- AV04:- I t 1 <br /> Address �} I OW- I3 .w r f <br /> Sample ID Lab ID Date •Time Matrix Container Pres g <br /> Number/Size <br /> to. v �h� `< <br /> 3 <br /> 4 <br /> 5 <br /> b <br /> 7 <br /> 8 <br /> I <br />� 9 <br /> I <br /> 10 <br /> I 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> I Fi <br /> Sample Receipt-To Be Filled By Laboratory Relinquished b � 1 Rehnqur b 2 Relinquished by 3 <br /> Sampler ed%, 4 Z�}-j"lin. <br /> Total Number of Containers Property Cooled Y/N/NA Signature Signature Signature <br /> Custody Seals Y/N/NA Samples Intact Y/N/NA Printed Name Printed Name Printed Name <br /> Received in Good Condition Y/N Samples Accepted Y/N ©ate 4btl + Time ivy r r� <br /> "0 Dale ime ate Time <br /> Turn Around Time Received B 1 Received By H ewed By 3 <br /> Signature gnatur <br /> YNormal L) Rush ❑24 his ❑7 72 ignature <br /> U Same Day L) 2 his Pri hrs N f� Pri am Printed Name <br /> Date lTime to / Time �j 34 Date Time <br /> Distribution Whrte-Laboratory Canary Laboratory Pink-Project/Account Manager Goldenrod 5amplerl0nginator if j <br />